Vasilis C. Babaliaros et al. JCIN 2017;10:

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Vasilis C. Babaliaros et al. JCIN 2017;10:

Presentation transcript:

Vasilis C. Babaliaros et al. JCIN 2017;10:798-809 LAMPOON to Enable Transcatheter Mitral Valve Replacement Inside a Flexible Mitral Annuloplasty Band (A) Left anterior oblique caudal short-axis fluoroscopic projection showing 2 retrograde catheters positioned before anterior mitral valve leaflet traversal. The retrograde LVOT and LA catheters overlap in this view, as intended. The posterior mitral valve band provides a fluoroscopic marker to position the LVOT catheter along the base of the A2 scallop. The LA catheter is directing the multiloop snare and is supported by a transseptal rail through a transseptal sheath. (B) A 3-dimensional transesophageal echocardiograph of the same step, with a LVOT catheter positioned at the base of the A2 scallop, and the LA catheter pointing a multiloop snare at the other side of the A2 scallop. (C) Initiation of laceration. The kinked guidewire cutting edge is circled in green. The transcatheter heart valve is pre-positioned at the orifice of the mitral valve. The LAMPOON guidewire is pulled outward to apply tension. (D) The LAMPOON guidewire is electrified during further pulling to initiate laceration. (E) Completed laceration, with both retrograde catheters insulating the wire safely in the descending aorta. The kinked guidewire cutting edge, adjacent to the radiopaque piggyback tip marker, is seen sheathed in the catheter. LA = left atrium; other abbreviation as in Figure 1. Online Video 2 is depicted in this figure. Vasilis C. Babaliaros et al. JCIN 2017;10:798-809 ©2017 by American College of Cardiology